Brody's Notes... San Francisco's Public Health Department Director Dr. Grant Colfax: Questions Around Cost, Access & Availability For New HIV Drug

Dr. Grant Colfax  Photo By Jim Wilson The New York Times

By Mark Singer (Washington DC) DEC 9 | Discussions over use of the new drug Truvada, which in a study released last month by San Francisco's Gladstone Institutes and published in the New England Journal of Medicine, showed that Gay and bisexual men who took a daily dose of the anti-retroviral drug, significantly reduced their risk of contracting HIV, are now complicated by questions of ethics and efficacy by both HIV-Aids activists and the medical community.

Dr. Grant Colfax, director of H.I.V. prevention and research in the San Francisco Department of Public Health told a reporter for the San Francisco Chronicle:

"We have a responsibility to work with the HIV/AIDS community on this potentially exciting intervention," said Dr.Colfax, "We have a very active community that is very engaged in health care, HIV prevention and treatment. What we need to ask is, does this potential intervention confer additional benefits as we try to end HIV infections in San Francisco?"

The U.S. Centers for Disease Control and Prevention in Atlanta, Georgia are still in the process of drawing up guidelines for the drug's use. The study of the drug's effectiveness had followed 2,499 men, 120 of whom were in San Francisco. In the published results, half of the study group were taking the drug Truvada and half taking a placebo. Among the group taking Truvada, which is used to treat people who are HIV-positive, 36 men contracted HIV, compared with 64 men in the placebo group.
According to Dr. Colfax who warns that the drug has only been proven to work for men who have sex with men, the study results showed it may not be as effective for women or intravenous drug users. Colfax told the Chronicle people who do use the drug for prevention will need to be tested regularly for both HIV and other sexually transmitted diseases. It should be confirmed that they are HIV-negative before they start taking the drug.And above all, men need to know that the drug seems to lose most of its preventive powers when it isn't taken regularly.
Kyriell Noon, Executive Director of  the Stop AIDS Project said;

"We are hearing from people who are raring to go on this, but this drug is just one of many HIV prevention strategies that are available to us. Condoms are still the best way to prevent HIV, and I think that needs to be shouted from the rooftops, so people don't convince their doctors to give them prescriptions, or get drugs from Canada."

In an interview with the New York Times last year, Dr. Colfax told the Times that he worried about disparities both in viral load and in care.

The Castro, for example, has more H.I.V. cases, but individuals in lower-income neighborhoods tend to have higher viral loads, the new research shows.

San Francisco has more than 15,000 reported cases of H.I.V./AIDS. Those numbers continue to rise. The new findings show that the sickest individuals tend to be African-American, homeless and transgender. The viral loads of African-Americans are about one-third higher than that of Latinos or whites.

The public health experts and researchers note that the above noted disparities also reflect a major concern in getting the drug introduced into the community for treatment & prevention. An obstacle to Bay Area HIV/AIDS groups who are hoping to launch a program sometime next year is that Truvada costs about $12,000 a year when used to treat HIV infection.
"Because the drug is so expensive, it may be nearly impossible to reach the men who need it, especially if they're young, uninsured and do not have significant financial resources available to them," Dr. Colfax told the Chronicle.

"This is a big breakthrough and there's a lot of hope," Colfax said. "But there are questions around cost, access and availability. We have to be optimistic and at the same time thoughtful about the questions that need to be answered."